title: Endoscopic gastrojejunostomy with a natural orifice transluminal endoscopic surgery technique.
abstract: OBJECTIVE
  To determine the technical feasibility and safety of an endoscopic gastrojejunostomy with a pure natural orifice transluminal endoscopic surgery (NOTES) technique using a T-anchoring device in a porcine survival model.
  
  
  METHODS
  An endoscopic gastrojejunostomy with a pure NOTES technique using a T-anchoring device was performed on 10 healthy female minipigs weighing approximately 40 kg each under general anesthesia. All procedures were performed with a transgastric approach using a 2-channel therapeutic endoscope.
  
  
  RESULTS
  The transgastric gastrojejunostomy was technically successful in all cases. A total of four to six stitched pairs of a T-anchoring device were used to secure the anastomosis. The median time required to enter the peritoneal cavity and pull the small bowel into the stomach was 34 min (range: 19-41 min); the median time required to suture the anastomosis was 67 min (range: 44-78 min). An obstruction of the efferent limb occurred in one case, and a rupture of the anastomosis site occurred in another case. As a result, the functional success rate was 80% (8/10). Small bowel adhesion to the stomach and liver occurred in one case, but the anastomosis was intact without leakage or obstruction.
  
  
  CONCLUSIONS
  A transgastric gastrojejunostomy with a T-anchoring device may be safe and technically feasible. A T-anchoring device may provide a simple and effective endoscopic suturing method.
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang 411-706, South Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Su Hui
authors.initials: SH
authors.lastname: Kim
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D000818:Animals; D019723:Endoscopes; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation; D013536:Suture Techniques; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors
keywords: Aanastomosis; Endoscopy; Natural orifice transluminal endoscopic surgery; Pigs